论精神病人强制收治——从徐武被精神病案谈起

以徐武被精神病案为例,近些年媒体报道了许多不是精神疾病患者的公民被强制收治到精神病院的事例。"被精神病"体现医疗鉴定以及精神卫生立法中的问题。关于强制收治中央立法缺位,地方立法无法全面覆盖。一部完善的《精神卫生法》急需出台,避免继续出现"被精神病"。     

反垄断普遍主义法理论、法原则探究

反垄断法作为市场经济社会的“经济宪法,”维护近现代商品生产社会的市场经济秩序、“有效竞争”市场结构。在历经百年的反垄断立法和实践中,确立了“本身违法”原则、合理原则、域外适用的“效果原则”。我国反垄断法的制定,应科学借鉴反垄断普遍主义法理论、法原则,规范我国社会主义市场经济秩序、竞争关系。     

精神疾病患者强制医疗的证明标准研究

证明标准是强制医疗程序中的关键问题。在美国,一般以“清晰和令人信服”标准作为非自愿治疗最低限度的证明标准,从而排除适用民事案件的“优势证据”标准。我国《精神卫生法》并未建立强制医疗司法审查模式,而是由精神卫生机构行使强制医疗的决定权,强制医疗决定程序中的证明责任和证明标准问题均被淡化。在刑事强制医疗诉讼中,则应根据不同的证明内容设置不同的证明标准。     

“被精神病”事件的预防程序与精神卫生立法

为了解决近年来频频出现的被精神病事件,我国需要加快精神卫生立法进程。虽然《中华人民共和国精神卫生法》不需要重复规定精神疾病的医学诊断标准,但需要确立一个能使现行医学诊断标准和治疗护理规范得到有效执行的正当程序。《中华人民共和国精神卫生法》应当依据国际公约《保护精神病患者和改善精神保健的原则》明确规定,只有法院或者依法设立的具有司法机关性质的独立主管机关才有权宣判精神病并决定是否需要对精神病人实施强制医疗;同时,应当承认精神病人始终具有法律上的权利主体资格和权利能力,切实保障当事人通过司法程序为自己正名的诉讼权利。对正常人恶意进行强制医疗的,应当按照刑法的相关规定严格追究其刑事责任。     

“有利原则”的提出及其在劳动合同法中的适用

“有利原则”是基于劳动法的立法宗旨而独立出现的一项劳动法的调整原则,有其独特的效力、适用范围和主要功能。劳动合同法中确立“有利原则”,宜采“概括式”与“列举式”相结合的模式。“有利原则”在劳动合同的订立、解除、终止、法律责任、争议处理等各项具体制度中有着极为广阔的适用空间。     

强制医疗的适用条件及其立法完善

我国现行刑法虽然从立法层面上确立了对精神障碍人的强制医疗制度,但是对适用条件没有作出明确、具体的规定。鉴于此,刑事立法应当明确规定适用强制医疗的实体条件是实施了刑法所禁止的行为,并且具有再度实施严重危害社会行为的危险性,具有强制医疗必要性的精神障碍人;在程序上,强制医疗应当由法院宣告,由公安机关送往安康医院或普通精神病院治疗。     

医疗费用保险是否适用损失补偿原则问题的探讨

在我国，保险立法中采“财产保险”与“人身保险”二分法的立法体制，因此，通说认为损失补偿原则仅适用于财产保险，排除其在人身保险中的适用。而疾病、伤害类医疗费用保险是否适用损失补偿原则，学术界众说纷纭，实务及法院判决中对此也有不同观点。保险在于补偿，在我国现有立法体制下，完全排除损失补偿原则在人身险中的运用，将有违保险原理。借鉴国外立法，立足于我国国情，明确损失补偿原则在疾病、伤害等医疗费用保险中的运用将是有益的尝试。     

强制医疗程序司法实务困境探析

2012年刑事诉讼法以一章六条形式确立了强制医疗特别程序,由此首次将强制医疗纳入基本法范畴,此举是我国刑事诉讼立法的重大进步,对于促进社会的安定有序具有重要意义。然因法律规定过于原则、配套法律法规不完备等因素,导致强制医疗程序在司法实践运行中面临案件证明标准不明、精神病人证言效力认定模糊、强制医疗决定权归属存在冲突一系列问题,需要在实践应用中进一步予以明确、细化和完善,从而真正实现立法原意。     

浅议强制医疗的解除

强制医疗前的各方程序、实体内容已基本完善,但解除强制医疗的程序和实体方面还存在某些缺项,特别是在解除时间、疗效及危险性评估、系统监护评估等问题上还需要进行完善。建议对被强制医疗对象的首次评估时间不低于3个月,然后每3个月复评一次,至少评估3次以上且达到临床缓解、危险性基本消除的情况下,方能提出解除申请;评估内容应针对精神症状、自知力及危险性等;评估机构可不限于"强制医疗机构",可适当引入司法鉴定机构;在解除强制医疗后,被强制医疗对象应由近亲属、派出所或其他管理组织(如居委会、疾控中心)加强监护。     

论我国精神卫生法基本原则的确立

精神卫生法的基本原则是指贯穿于全部精神卫生法之中,体现精神卫生立法的基本精神和根本价值,用以指导精神卫生法的制定和实施的基本法律准则。调整的对象的特殊性和所处发展阶段的特殊性决定了基本原则之于我国精神卫生法的特殊意义。精神卫生法基本原则的确定不仅要有法律依据,更应该建立在反映该法根本价值和基本矛盾的理论基础之上;不仅要正视精神卫生工作进展滞后形势堪忧的严峻现实,回应社会实践对精神卫生法的强烈需求,还应尊重精神卫生防治规律,顺应世界精神卫生立法的时代潮流。     

论精神障碍患者强制住院异议机制的完善

以维护精神障碍患者的合法权益为立法宗旨、经过27年反复斟酌的《精神卫生法》终于出台，填补了精神卫生领域立法的空白，也将人权保障写入法律。精神障碍患者以自愿住院为原则，强制住院为补充，减少了“被精神病”的发生，但是对于强制住院的异议机制规定甚少且可操作性不强，不利于维护精神障碍患者的权利。在借鉴国外精神障碍强制住院异议制度的基础上，从提出异议的主体、异议机构以及异议程序方面，结合我国国情，对强制住院异议机制进行完善。     

论《精神卫生法》的自愿原则

为了防止正常人"被精神病",更好地保护精神障碍患者的合法权益,《精神卫生法》确立了自愿原则。该原则渊源于私法领域的自愿原则而又与其不同,是在知情的条件下对精神卫生服务的单方接受自愿。它回应了要像人一样保护精神障碍患者,彰显了精神卫生法的福利法本质。它包涵自愿诊断、自愿治疗和自愿出院三个既相互区别又相互联系子原则。非自愿诊断、非自愿治疗、非自愿继续住院治疗只是自愿原则的补充,此种例外旨在寻求患者精神健康权与社会公众安全保护的平衡。     

精神障碍患者非自愿收治程序设计的若干法律问题研究(上)刘瑞爽

对于精神障碍患者的非自愿收治,应注意保障患者的人身权利,尤其是合理程序保障的权利。比较分析国际上的各国立法,在收治程序各个环节上,均须体现出对人权的保护,其主要问题有：制定强制收治的标准、送治主体、收治主体、初步裁定的步骤和时限、对初步裁定的救济、法律代表人制度、司法审查的介入（或独立第三方的介入）、危险的证明、避免无限期拘留而进行的后续定期审查、患者方获取信息的权利保障、上诉等。我国应坚持程序正义原则,借鉴国际上先进立法经验,弥补我国精神障碍患者非自愿收治程序设计的立法漏洞。     

精神卫生法的理想与现实

《精神卫生法》的立法经历了一个极其漫长的过程,最终出台的法律文本仍然存在非常严重的问题,其立法所要解决的问题所要达到的目的非常高,而与中国的现实严重脱节。《精神卫生法》立法的三大理想中,保护精神病患者的合法权益是核心,并希望立法来解决包括被精神病等一系列的社会现实问题。但是,立法脱离现实,相关的内容甚至出现了错误,表现在精神病患者的收治、实施导致人体器官丧失功能的外科手术、急诊急救、基层医疗机构的精神卫生保障等方面。由于存在不切合中国实际国情的规定,《精神卫生法》在我国的实施将会大打折扣。建议《精神卫生法》重点关注严重精神疾病患者得不到治疗、肇事肇祸的严重精神疾病患者得不到强制医疗的现象,关注财政投入不足、强制收治不规范等方面的问题。     

论精神病人的民法监护——以民事强制住院司法实践为视角

目前．世界多数国家关于精神病人强制住院的立法都直接与广义上的监护法律相联系。监护制度在保护民事行为能力欠缺的精神障碍患者的身心安全和提供必要的住院及医疗措施方面发挥了重要作用。然而,由于我国关于精神病人监护制度的法律规定较为简陋和滞后,导致了实践中,特别是在涉及民事强制住院措施适用时,很多精神病人的人身自由和健康权益并没有得到有效照管,甚至受到严重侵害,由此引起的医疗纠纷和诉讼也日益增多。在此试图对我国精神病人民法监护制度进行解构分析,以期为进一步完善适合我国国情的精神病人监护制度和维护精神病人健康权益提供一些立法建议。     

Why community compulsion became the solution - Reforming mental health law in Sweden

The aim of this article is to understand how compulsory community care (CCC) has become a solution in mental health policy in so many different legal and social contexts during the last 20 years. The recent introduction of CCC in Sweden is used as a case in point, which is then contrasted against the processes in Norway, England/Wales and New York State.In Sweden, the issue of CCC was initiated following high-profile acts of violence. Contrary to several other states, there was agreement about the (lack of) evidence about its effectiveness. Rather than focusing on dangerousness, the government proposal about CCC was framed within an ideology of integrating the disabled. The new legislation allowed for a broad range of measures to control patients at the same time as it was presented as a means to protect positive rights for patients. Compared to previous legislation in Sweden, the scope of social control has remained largely the same, although the rationale has changed — from medical treatment via community treatment and rehabilitation, to reducing the risk of violence, and then shifting back to rehabilitation in the community.The Swedish approach to CCC is similar to Norway, while New York and England/Wales have followed different routes. Differences in ideology, social control and rights orientations can be understood with reference to the general welfare and care regimes that characterize the four states.     

Obligatory dangerousness criteria in the involuntary commitment and treatment provisions of Australian mental health legislation

Objective

Involuntary commitment and treatment (IC&T) of people affected by mental illness may have reference to considerations of dangerousness and/or need for care. While attempts have been made to classify mental health legislation according to whether IC&T has obligatory dangerousness criteria, there is no standardised procedure for making classification decisions. The aim of this study was to develop and trial a classification procedure and apply it to Australia's mental health legislation.

Method

We developed benchmarks for ‘need for care’ and ‘dangerousness’ and applied these benchmarks to classify the mental health legislation of Australia's 8 states and territories. Our focus was on civil commitment legislation rather than criminal commitment legislation.

Results

One state changed its legislation during the course of the study resulting in two classificatory exercises. In our initial classification, we were able to classify IC&T provisions in legislation from 6 of the 8 jurisdictions as being based on either ‘need for care’ or ‘dangerousness’. Two jurisdictions used a terminology that was outside the established benchmarks. In our second classification, we were also able to successfully classify IC&T provisions in 6 of the 8 jurisdictions. Of the 6 Acts that could be classified, all based IC&T on ‘need for care’ and none contained mandatory ‘dangerousness’ criteria.

Conclusions

The classification system developed for this study provided a transparent and probably reliable means of classifying 75% of Australia's mental health legislation. The inherent ambiguity of the terminology used in two jurisdictions means that further development of classification may not be possible until the meaning of the terms used has been addressed in case law. With respect to the 6 jurisdictions for which classification was possible, the findings suggest that Australia's mental health legislation relies on ‘need for care’ and not on ‘dangerousness’ as the guiding principle for IC&T.     

强制治疗精神疾病患者的程序法研究——基于国内六部地方性法规的实证分析

对精神疾病患者实施强制治疗程序包括强制送治程序和强制治疗程序,由于该程序涉及到对人身自由的限制,应该严格遵循法治行政的原则。不过,国内各地所制定的六部精神卫生条例,赋予该程序的法根据并不充足;同时,程序法上的规定也并非十分完善。因此,我国应该尽快制定《精神卫生法》,详细规定强制治疗的程序,为保障精神疾病患者的权益提供坚实的法律根据。     

Compulsory mental health care in Norway: The treatment criterion

The Norwegian government has chosen to retain a treatment criterion in the Mental Health Care Act despite the opposition of several user organizations. From a critical user perspective, the only reason for using coercion to require mental health treatment is that the individuals are in a state where they are an immediate danger to themselves and/or their surroundings. This articles aims, first, to provide an overview of research studies concerning the benefits or harmfulness of involuntary treatment after coerced admission and, second, to evaluate studies that try to compare involuntary with voluntary treatment. A systematic overview of studies of compulsory mental health care with regard to treatment criteria, coercion in mental health, and involuntary admission published over the last decade was examined in detail, along with a secondary manual search of references cited in identified publications. Few studies have been conducted on the effect of compulsory mental health care, and the results have been contradictory. More randomized studies are needed to document the kinds of effects that the use of compulsory treatment has on treatment results. Another issue that needs further examination is whether the use of coercion should be transferred to legal bodies with an adjudicatory process.     

Involuntary detention and treatment of the mentally ill: China's 2012 Mental Health Law

The long-awaited Mental Health Law of China was passed on 26 October 2012 and took effect on 1 May 2013. Being the first national legislation on mental health, it establishes a basic legal framework to regulate mental health practice and recognizes the fundamental rights of persons with mental disorders. This article focuses on the system of involuntary detention and treatment of the mentally ill under the new law, which is expected to prevent the so-called “Being misidentified as mentally disordered” cases in China. A systematic examination of the new system demonstrates that the Mental Health Law of China implicitly holds two problematic assumptions and does not provide adequate protection of the fundamental rights of the involuntary patients. Administrative enactments and further national legislative efforts are needed to remedy these flaws in the new law.